Lack of space between primary teeth

When my 5 year old daughter started going to the dentist last year, he mentioned that the spaces between her teeth were very good because her permanent teeth would have room to grow into her mouth. My three year old daughter, however, has absolutely no space between her teeth. Will this cause problems with her permanent teeth?


Dear Sarah,

Because individuals vary so greatly, it is hard to predict if your daughters will have orthodontic problems. Crowding of the permanent teeth can occur when there is a discrepancy between the size of the teeth and the size of the arch in which the teeth are located. Because the size of the teeth are determined at a very early age, the main variable is the change in arch size.

Most of the dimensional changes in the arch occur during the time of eruption and loss of teeth. Otherwise, the dimensions of the arch are generally unchanged. The greatest rate of change in arch size seems to occur between birth and 3 years old. The next significant change in arch size seems to occur about the time of eruption of the first permanent molars and the permanent incisors (about 6-7 years old). This change may be insignificant, however, depending upon the size and eruption patterns of these teeth.

One of the primary determinants of adequate space has to do with "primate" spaces, the spaces between the primary teeth (such as what you describe with your first daughter). Without these primate spaces, crowding of the permanent teeth is more likely to occur. Some spacing may be gained through "leeway space". The permanent teeth which replace the primary molars, called premolars, are slightly smaller than their primary counterparts. This space generally closes as the permanent teeth continue to erupt. If it appears, however, that enough space can be gained by maintaining the "leeway space", an appliance can be placed to utilize this space to help correct modest amounts of crowding in the permanent incisors.

The alignment of the permanent teeth depends to some extent on the arch perimeter of the primary teeth, the changes in arch size as the primary teeth are lost and the permanent ones erupt, and the size of the permanent teeth replacing the primary teeth. As your daughters begin to lose their primary teeth and as their permanent teeth begin to erupt, your dentist should monitor their development. If a discrepancy in tooth size and arch space is noted and/or if a problem with their occlusion (relationship of upper and lower teeth) is noted, a referral to an orthodontist should be made. If necessary, early intervention can be done to utilize your daughter's growth potential to either create or maintain space for her permanent teeth.

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